I don’t report everything as a CNA … is it okay to let my nurse assess

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I USUALLY chart EVERYTHING. I'm learning to step back and stop putting unnecessary stress on myself. At work a few nights ago my nurse questioned my ability to do my job because out of ALL my patients she didn't like that this patients vitals were high. I don't lie or add fake numbers. I'm actually one of the only staff who doesn't just chart 18. I just count ?‍♀️ there are times I struggle because I'm doing my job correct but the patient has low breathing rate. Sometimes patients hold their breath while getting their vitals. I had a patient that I didn't record any breathing for all night HOPING I'd get one good number. I did watch from outside of their room and I think I got a good number..didn't record it but was comfortable knowing in my heart they were not in distress. Eventually told my charge nurse that I had no number recorded because it all looked so low. Admitted their sleep rate was extremely low but asked could she assess. I am done carrying a burden  of shame for being honest so now I’ll give the burden back to the nurse to assess themself. Honesty has caused me major anxiety at work and insecurity. My bestfried who is a nurse basically agrees that I should just put a “normal number” if they don't appear to be in distress.  I'll leave it blank before I falsify a number. My anxiety is trying to make this a huge issue and it's trying to guilt me into feeling undeserving of a job. I always think “if I don’t record MY number and everyone else is lying … someone could die because of me”. Is it wrong to allow the nurses to assess themselves and me not put anything for a number that is deemed too high or too low ? I’m tired of being treated like I’m dumb when they see the answers I submitted. I’ll put the right and they’ll still chart next to mine “18”. I can’t win. 

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Specializes in Psych, Addictions, SOL (Student of Life).

Why are you so anxious and afraid. This anxiety will doom any nuursing career. If you document a low respiratory rate and your nurse then assesses that it's normal that's OK. Maybe that nurse roused the patient and got a more accurate rate. What if you don't record a rate that is low and the patient suffers for it! Besides as a CNA you are not supposed to be assessing patients. Your scope of practice in almost all states is to observe and report, then let the nurse decide if it is normal or abnormal.

 

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10 hours ago, hppygr8ful said:

Why are you so anxious and afraid. This anxiety will doom any nuursing career. If you document a low respiratory rate and your nurse then assesses that it's normal that's OK. Maybe that nurse roused the patient and got a more accurate rate. What if you don't record a rate that is low and the patient suffers for it! Besides as a CNA you are not supposed to be assessing patients. Your scope of practice in almost all states is to observe and report, then let the nurse decide if it is normal or abnormal.

 

If the nurse “roused” then is not a form of manipulating the numbers ? I’ve even decided to not take respirations while the patient is sleeping and wait until they’re awake. Still sometimes the same result. I’ve had a nurse say “get the respirations now “ after A patient was startled out of their sleep. I totally agree with you. But I ALWAYS do the right thing and put the accurate numbers just for the nurse to chart next to mine “18” or question me like I’m stupid. Leaving it blank in my opinion outside of me notifying the nurse also says “okay it’s blank …there’s nothing there .. I (nurse) need to ask why or assess and enter a number “ … it’s affecting my mental health. At first I pretended and thought maybe I’m not sure in my numbers if everyone else is getting 18. But I knew I was discounting myself. Now it’s offensive and causing me stress to do the right thing and then be told “it makes us look like we don’t know what we are doing “…. This isn’t an everyday occurrence but I had to choose my sanity and walk away. I know my job is to report and document. I have been told by my charge to maybe let the nurse assess before documenting an abnormal rate. 

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Specializes in Psych, Addictions, SOL (Student of Life).
4 hours ago, Anxiousandafraid said:

If the nurse “roused” then is not a form of manipulating the numbers ? I’ve even decided to not take respirations while the patient is sleeping and wait until they’re awake. Still sometimes the same result. I’ve had a nurse say “get the respirations now “ after A patient was startled out of their sleep. I totally agree with you. But I ALWAYS do the right thing and put the accurate numbers just for the nurse to chart next to mine “18” or question me like I’m stupid. Leaving it blank in my opinion outside of me notifying the nurse also says “okay it’s blank …there’s nothing there .. I (nurse) need to ask why or assess and enter a number “ … it’s affecting my mental health. At first I pretended and thought maybe I’m not sure in my numbers if everyone else is getting 18. But I knew I was discounting myself. Now it’s offensive and causing me stress to do the right thing and then be told “it makes us look like we don’t know what we are doing “…. This isn’t an everyday occurrence but I had to choose my sanity and walk away. I know my job is to report and document. I have been told by my charge to maybe let the nurse assess before documenting an abnormal rate. 

No rousing a patient who is sleeping with a low respiratory rate say 14 is not manipulating the numbers. It's checking to see if the low rate has caused the patient to become unconscious. In the scenario you describe I would go to the patint tap them lightly on the shoulder as see if they are rousable. if they wake a new respiratory rate is normal that's a good thing. It means the patient is able to return to a normal rate on waking. If you can't get what you think is an accurate rate then you must at least note that you observed the rise and fall of the chest indicating respirations are present.

If a nurse questions you it's for clarification not because they think you are stupid. No one can make you feel something unless you allow yourself to feel it. That is a universal truism.

Why do you say I (nurse)? You are not a nurse you are a CNA. Most of the CNAs I have worked with are incredibly astute and very hard workers and there is no shame in wearing your role with pride but don't call yourself a nurse. In some states the "Nurse" is a protected legal title and you can get inserious legal trouble applying it to yourself. 

Sorry to say this but if you are doing your job the way you describe then you don't know what you are doing and a patient could die on you due to you not recording the low rate and notifying the RN. CNAs have been prosecuted for less. 

If the normal duties of being a CNA cause you this much stress you sure don't want to be a licensed nurse. In the part of the country where I work CNAs barely make a minimum subsistance wage which is a shame for how hard they (You) work. You could let go off all this anxiety and sell or flip bergers for less stress.

I'm not saying this to be cruel but you got to know where your talents lie. \

Hppy 

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6 hours ago, hppygr8ful said:

No rousing a patient who is sleeping with a low respiratory rate say 14 is not manipulating the numbers. It's checking to see if the low rate has caused the patient to become unconscious. In the scenario you describe I would go to the patint tap them lightly on the shoulder as see if they are rousable. if they wake a new respiratory rate is normal that's a good thing. It means the patient is able to return to a normal rate on waking. If you can't get what you think is an accurate rate then you must at least note that you observed the rise and fall of the chest indicating respirations are present.

If a nurse questions you it's for clarification not because they think you are stupid. No one can make you feel something unless you allow yourself to feel it. That is a universal truism.

Why do you say I (nurse)? You are not a nurse you are a CNA. Most of the CNAs I have worked with are incredibly astute and very hard workers and there is no shame in wearing your role with pride but don't call yourself a nurse. In some states the "Nurse" is a protected legal title and you can get inserious legal trouble applying it to yourself. 

Sorry to say this but if you are doing your job the way you describe then you don't know what you are doing and a patient could die on you due to you not recording the low rate and notifying the RN. CNAs have been prosecuted for less. 

If the normal duties of being a CNA cause you this much stress you sure don't want to be a licensed nurse. In the part of the country where I work CNAs barely make a minimum subsistance wage which is a shame for how hard they (You) work. You could let go off all this anxiety and sell or flip bergers for less stress.

I'm not saying this to be cruel but you got to know where your talents lie. \

Hppy 

I put “ “ because I was NEVER labeling myself as a nurse. I was saying that’s what the nurse would possibly think when they are charting and notice there’s nothing there … the nurse checks the chart all thru out the night. So I was saying when they notice nothing is there they will say to themselves. So thanks but again I wasn’t labeling myself a nurse. It’s interesting it’s universally almost accepted for everyone to just document 18 but me leaving it blank or telling my nurse that I’m getting a low rate and allowing them to check it instead of putting the low rate is considered terrible. And the patient was awake I was referring to. I mentioned that in my initial post that at times I believe the patient holds their breath while I’m obtaining their full set of vitals. And you’re absolutely correct. I do NOT want to be a nurse. Never have wanted to. I love my job and again as I said I always do the right thing even when I’ve been told by my boss they know people lie and just chart 18.  And again I DID notify the RN. I also said that in my initial post. I notified my charge and asked her to assess. Did I chart the low rate .. no. Did I also say I stood outside the door and saw the patient breathing at a decent rate yes. But thanks. Maybe I’ll go flip a burger. 

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Specializes in Clinical Research, Outpt Women's Health.

Just chart what you get. Not charting anything is not the answer.

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16 hours ago, hppygr8ful said:

No rousing a patient who is sleeping with a low respiratory rate say 14 is not manipulating the numbers. It's checking to see if the low rate has caused the patient to become unconscious. In the scenario you describe I would go to the patint tap them lightly on the shoulder as see if they are rousable. if they wake a new respiratory rate is normal that's a good thing. It means the patient is able to return to a normal rate on waking. If you can't get what you think is an accurate rate then you must at least note that you observed the rise and fall of the chest indicating respirations are present.

If a nurse questions you it's for clarification not because they think you are stupid. No one can make you feel something unless you allow yourself to feel it. That is a universal truism.

Why do you say I (nurse)? You are not a nurse you are a CNA. Most of the CNAs I have worked with are incredibly astute and very hard workers and there is no shame in wearing your role with pride but don't call yourself a nurse. In some states the "Nurse" is a protected legal title and you can get inserious legal trouble applying it to yourself. 

Sorry to say this but if you are doing your job the way you describe then you don't know what you are doing and a patient could die on you due to you not recording the low rate and notifying the RN. CNAs have been prosecuted for less. 

If the normal duties of being a CNA cause you this much stress you sure don't want to be a licensed nurse. In the part of the country where I work CNAs barely make a minimum subsistance wage which is a shame for how hard they (You) work. You could let go off all this anxiety and sell or flip bergers for less stress.

I'm not saying this to be cruel but you got to know where your talents lie. \

Hppy 

I apologize for my defensive response. All in all … I’m just going to document what I get and move on. If they(nurses)  get mad ,oh well. I come to do a job and I’ll do it. It’s not (their attitudes ) worth the stress I feel later hoping no one “suffered or died because of me “ by trying to appease them with my answers I obtained . Thank you for your response. 

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Specializes in Geriatrics, Dialysis.

Some people just have a lower respiratory rate. It bugged me to no end in the SNF when everybody would chart 16 or 18 for the rate every time. I would be the only RN charting respirations "14 per baseline" 

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Specializes in oncology.
On 8/10/2022 at 11:32 PM, hppygr8ful said:

Sorry to say this but if you are doing your job the way you describe then you don't know what you are doing and a patient could die on you due to you not recording the low rate and notifying the RN.

From what I read the OP is doing her/his job. Being conscientious. I have worked in hospitals where one CNA will say to another ..."just chart 16 or 18 , that is what I do."  

1) hppygr8ful: you are not sorry to say this as you ended your statement with a scary thought for a new CNA. 

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you don't know what you are doing and a patient could die on you due to you

2) the OP is just trying to understand a role that has honest employees and well, dishonest employees. Those that care...those that don't care. Wouldn't it be a better response to provide support for someone who really wants to do good in health care?

A fellow RN of mine had her mother-in-law in a Kindred long-term care place. She suspected that her MIL was not getting any personal care that involved bathing or change of gown. My friend put a safety pin on her MIL's gown in a place that would not cause any discomfort.. She visited  the next day, and the next. . The same safety pin was still there. She enquired when her MIL was provided bathing/personal care. She was told every day. She got out a basin and washed her MIL herself. 

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Specializes in oncology.
On 8/10/2022 at 11:32 PM, hppygr8ful said:

It's checking to see if the low rate has caused the patient to become unconscious. In the scenario you describe I would go to the patint tap them lightly on the shoulder as see if they are rousable. if they wake a new respiratory rate is normal that's a good thing. It means the patient is able to return to a normal rate on waking.

Ummm. may be sleep apnea is occurring? Documenting the rate prior to waking them up is invaluable. 

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Specializes in Psych, Addictions, SOL (Student of Life).
27 minutes ago, londonflo said:

Ummm. may be sleep apnea is occurring? Documenting the rate prior to waking them up is invaluable. 

I forgot to state that the RN should assess patient's respiratory rate before rousing and after.  I stand corrected.

 

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Specializes in Med nurse in med-surg., float, HH, and PDN.

One place I worked , resp rates were often charted as "WNL" (within normal limits) but I don't think that's accepted any more. Also some charted "reported low resp rate to RN." But I was told that if the nurse didn't follow up on that, it could "get her in trouble."

Darned if ya do, darned if ya don't.

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